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弥漫性星形细胞瘤向胶质母细胞瘤的恶性转化与新出现的BRAF V600E突变相关。

Malignant transformation of diffuse astrocytoma to glioblastoma associated with newly developed BRAF V600E mutation.

作者信息

Kanamori Masayuki, Suzuki Hiroyoshi, Takei Hidehiro, Sonoda Yukihiko, Uenohara Hiroshi, Tominaga Teiji

机构信息

Department of Neurosurgery, Sendai Medical Center, 2-8-8 Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.

Department of Pathology and Laboratory Medicine, Sendai Medical Center, Sendai, Miyagi, Japan.

出版信息

Brain Tumor Pathol. 2016 Jan;33(1):50-6. doi: 10.1007/s10014-015-0231-7. Epub 2015 Sep 24.

Abstract

A 29-year-old man presented with scintillation scotoma. MR imaging demonstrated a diffuse lesion in right parahippocampal gyrus. He underwent a biopsy, and the diagnosis was diffuse astrocytoma. Because of enlargement and new areas of gadolinium enhancement, the tumor was resected 18 months after biopsy. Histological examination revealed malignant transformation to glioblastoma with small areas of epithelioid component. He received radiation and temozolomide chemotherapy. Local recurrence was found 20 months after first resection. He underwent second resection, and the diagnosis was glioblastoma. DNA from the micro-dissected paraffin-embedded sections were analyzed for the mutation of the isocitrate dehydrogenase1 (IDH1) and IDH2 and v-RAF murine sarcoma viral oncogene homolog B1 (BRAF) genes. No mutations of the IDH genes were detected in any tumor specimen. In contrast, missense mutation at codon 600 in the BRAF gene (BRAF V600E) was found exclusively in the malignant areas from both resected glioblastoma specimens. We screened other genetic aberrations commonly seen in glioblastoma with multiplex ligation-dependent probe analysis. Deletion of CDKN2A and CDKN2B loci was found both in diffuse astrocytoma and glioblastoma component, but no other significant alterations were found. This case suggests that the BRAF V600E mutation may be involved in the malignant transformation to glioblastoma.

摘要

一名29岁男性出现闪光暗点。磁共振成像显示右侧海马旁回有弥漫性病变。他接受了活检,诊断为弥漫性星形细胞瘤。由于肿瘤增大且出现新的钆增强区域,在活检18个月后进行了肿瘤切除。组织学检查显示已恶变为胶质母细胞瘤,伴有小面积上皮样成分。他接受了放疗和替莫唑胺化疗。首次切除后20个月发现局部复发。他接受了二次切除,诊断为胶质母细胞瘤。对显微切割的石蜡包埋切片的DNA进行了异柠檬酸脱氢酶1(IDH1)、异柠檬酸脱氢酶2(IDH2)和v-RAF鼠肉瘤病毒癌基因同源物B1(BRAF)基因的突变分析。在任何肿瘤标本中均未检测到IDH基因的突变。相比之下,BRAF基因第600密码子的错义突变(BRAF V600E)仅在两个切除的胶质母细胞瘤标本的恶性区域中发现。我们用多重连接依赖探针分析法筛查了胶质母细胞瘤中常见的其他基因畸变。在弥漫性星形细胞瘤和胶质母细胞瘤成分中均发现CDKN2A和CDKN2B基因座缺失,但未发现其他明显改变。该病例提示BRAF V600E突变可能参与了向胶质母细胞瘤的恶性转化。

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